Case Report
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Sep 28, 2009; 15(36): 4596-4600
Published online Sep 28, 2009. doi: 10.3748/wjg.15.4596
Post-gastrectomy acute pancreatitis in a patient with gastric carcinoma and pancreas divisum
I-Ming Kuo, Frank Wang, Keng-Hao Liu, Yi-Yin Jan
I-Ming Kuo, Frank Wang, Keng-Hao Liu, Yi-Yin Jan, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan, China
Author contributions: Kuo IM contributed to manuscript preparation, manuscript editing and was the primary writer of the manuscript; Wang F revised the manuscript; Liu KH contributed to data collection and manuscript review; Jan YY reviewed the manuscript.
Correspondence to: Dr. Keng-Hao Liu, Department of Surgery, Chang Gung Memorial Hospital, 5, Fu-Shin Street, Kweishan, Taoyuan, Taiwan, China.
Telephone: +886-3-3281200 Fax: +886-3-3285818
Received: July 11, 2009
Revised: August 6, 2009
Accepted: August 13, 2009
Published online: September 28, 2009

Gastrectomy is commonly performed for both benign and malignant lesions. Although the incidence of post-gastrectomy acute pancreatitis (PGAP) is low compared to other well-recognized post-operative complications, it has been reported to be associated with a high mortality rate. In this article, we describe a 70-year-old man with asymptomatic pancreatic divisum who underwent palliative subtotal gastrectomy for an advanced gastric cancer with liver metastasis. His post-operative course was complicated by acute pancreatitis and intra-abdominal sepsis. The patient eventually succumbed to multiple organ failure despite surgical debridement and drainage, together with aggressive antibiotic therapy and nutritional support. For patients with pancreas divisum or dominant duct of Santorini who fail to follow the normal post-operative course after gastrectomy, clinicians should be alert to the possibility of PGAP as one of the potential diagnoses. Early detection and aggressive treatment of PGAP might improve the prognosis.

Keywords: Acute Pancreatitis, Gastrectomy, Pancreas divisum, Duct of Santorini, Laparoscopy